Decision Review Officer Process
The steps that the Veterans Benefits Administration (VBA) will follow to adjudicate your claim for disability benefits are complex and detailed.
Your claim is received, checked to determine your eligibility, evidence is gathered and put in place in your folder, you are given a Compensation and Pension examination, you are notified a number of times of your opportunity to submit more evidence and the folder is perfected by a Veterans Service Representative (VSR). Eventually your claim is ready for adjudication and it marches on to the desk of the Ratings Veterans Service Representative (RSVR).
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The RSVR is under tremendous pressure to turn out a given volume of work. This VA employee operates on a quota that doesn't allow the time that would be necessary to do a thorough reading of your entire folder. This is one of the points in the process where serious mistakes often occur.
It is more likely than not that the decision you receive will be wrong. You may receive a denial of your application for a benefit or a rating that is much lower than the rating you believe you deserve at this stage.
Upon receiving your award letter and discovering that the decision is flawed, you have one year to appeal that decision. This appeals process allows a variety of paths to an appeal.
You may ask that your case is sent to the Board of Veterans Appeals (BVA) for a complete review by a higher authority. You may seek "reconsideration" by the same people who denied it in the first place.
Alternatively, you may ask that your case be appealed by using the DRO Process. This is the method recommended by VAWatchdog.
The Decision Review Officer is a senior employee with greater training and experience and significant authority to make independent decisions. The Decision Review Officer process is a "de novo" review. This means that the individual who is reviewing your claim has not been previously involved in the review of your file and brings no bias or preconceived ideas to the task.
In my own experience with numerous Decision Review Officer reviews, I believe that this is the first time that any individual in the system will actually sit down and read your entire file.
When you receive a denial letter, you must soon appeal. VAWatchdog recommends that you write a Notice Of Disagreement (NOD) letter soon after you receive the denial. The NOD does not have to explain why you are disagreeing with the decision, it merely starts the process for the appeal. You must ask for DRO Process in that NOD letter.
The message below explains this in more detail.
Your Benefits - Jim's Mailbag...The DRO Process
Dear Jim,
After following you for several years, I have finally succeeded in getting a DRO Hearing. Your guidance and tips have been fundamental in success. Yes you do have to be very patient and just roll with the punches. All Vet's should give thanks to your experience and guidance. I still have a VSO, but most of my work has been on my own. Document and get receipts for everything you send to the VA. They lose stuff every day.
Received my C-File after a 6 month wait, and it was over 12 inches high. Still missing items that I had sent.
Now what should I expect? Do I need to set down with the VSO before the hearing or just show up?
Thanks for your guidance and help in all regards.
Reply,
Good work! I'm really pleased to hear that you're on top of this. It's my experience and opinion that this is the best way to force the system to get it right for you.
I'm not sure why you still rely on your VSO for help. You're doing all the work. He/she will get all the credit...and get paid for what you've done.
In any case, whether or not you try to meet with a VSO representative before the DRO hearing is your call. Typically, the representative won't meet with you until an hour or less prior to the DRO hearing. In theory, that individual will show up to greet you and by then they will be familiar with your case and have a game plan developed. It's my experience that it doesn't always work that way. I hear from many vets who tell me their representative didn't show until moments before the hearing and that they weren't well prepared. It depends on the individual VSO. As you know, one of my constant complaints about the VSO system is that there are no nationally accepted standards of practice that say how a VSO must perform.
If you have given an organization your POA, it's likely that someone will show up at the hearing to be there with you. I'd recommend that you develop your own game plan as to how to approach the hearing. Be prepared. This means that you must know exactly what you will say. You're there because you believe that VA has wrongfully denied you a benefit that you applied for and that you deserve.
Now it's time to state your case. Tell the hearing officer, "This is what I applied for. This is why I applied. This is what you told me when you denied me the benefit. This is why I believe you're wrong. This is the benefit I believe I deserve."
If you look at that, you'll see 5 elements of a statement. You must be clear with each step. Be precise. The veteran who walks in and says "You guys are wrong" but can't prove it will lose.
I urge vets to write out their statement days or even weeks ahead of time. Once you write it, trim it down. Keep trimming until it fits on a single page of paper. You want to be able to read your statement into the record in less than 5 minutes. The less you say, the more powerful each word is. Rambling and getting emotional doesn't help. Then, practice your statement. Your family is always a good audience. I was taught to practice in front of a mirror with a timer right where I could see it.
As lawyers have become much more interested in representing veteran clients at the VA Regional Office level of appeal, I'm recommending that most vets drop their VSO representation and retain a licensed professional. I've seen a trend for attorneys to file a brief with the DRO rather than try to get to a personal hearing. The brief serves the same purpose as the personal statement that I'm telling you about. It explains the history of the claim and tells the VA why they made a mistake. Once it's in the record, VA must give it the same consideration and weight as any personal hearing. This saves a lot of time for everyone.
Many hearings are decided before you walk in the room. Cases aren't investigated like we think they are. We all watch too many CSO television shows and we like to think that a lot of thought is put into investigating things. The truth is that your file is assembled over a period of time by any number of people. This is often called "perfecting" the folder. Once it's perfected it sits there and waits its turn. Often enough, it isn't looked at again until minutes before your hearing. The hearing officer will spend 5 minutes looking at the pertinent parts of the folder and by then the decision is pretty much made. I've had 2 personal hearings myself where I walked up to check in and I was told the hearing was canceled. The decision had been made in my favor and there was no reason for a hearing.
If you are confident that you're up to presenting your case for yourself, you should go for it. Show up at least a couple of hours before the scheduled time. Parking is often miserable and you don't want to be late. If you have any doubts, you may still retain a lawyer and delay the hearing. The lawyer will help you with doing that. I understand that if you win your appeal you'll still have to pay an attorney the usual fee and that is always a concern. However, if you aren't confident in your ability to present your case and you don't know your VSO well enough to understand what he/she will do for you, you must consider professional legal representation. If the DRO denies you because you aren't well prepared, the next step is the BVA. I do all I can to avoid the BVA. Most well grounded cases can be resolved at the VARO. It's worth the effort to keep it there.
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